Download Nausea and Vomiting - Cancer Care Ontario

How to Manage Your
Nausea and
Vomiting
The recommendations in this guide are based on published evidence and expert consensus. The
information in this guide was adapted from the following patient tools:
• Eating Tips for Dealing with Nausea
(University Health Network)
• Nausea and Vomiting (Sunnybrook Health
Sciences Centre)
• Ideas to help manage nausea
(North York General)
• Nausea and Vomiting (London Health
Sciences Centre)
• Tips to help you manage your symptoms:
Nausea and Vomiting (The Ottawa Hospital)
This patient guide was created by Cancer Care Ontario to provide patients with information about
nausea and vomiting. It should be used for information only and does not replace medical advice.
This guide does not include all information available about managing nausea and vomiting. Always
ask your health care team if you have questions or concerns. The information in this guide does not
create a physician-patient relationship between Cancer Care Ontario and you.
Need this information in an accessible format?
1-855-460-2647 | TTY (416) 217-1815 | publicaff[email protected]
For other patient symptom management guides please go to:
www.cancercare.on.ca/symptoms
Was this patient guide helpful? Let us know at: http://cco.fluidsurveys.com/s/guides/
Version 2 – 2016
Cancer Care Ontario retains all copyright, trademark and all other rights in the guide, including all text and graphic
images. No portion of this Resource may be used or reproduced, other than for personal use, or distributed,
transmitted or "mirrored" in any form, or by any means, without the prior written permission of Cancer Care Ontario.
This patient guide will help you understand:
What is cancer-related nausea and vomiting?
pg 2
What causes cancer-related nausea and vomiting?
pg 3
What can I do to manage my nausea and vomiting?
pg 4
When should I talk to my health care team?
pg 12
Where can I get more information?
pg 14
This guide is for people who have cancer-related nausea
and vomiting before, during or after cancer treatment. It
can be used by patients and the patient’s family, friends or
caregivers. It does not replace advice from your health
care team.
What is
nausea and vomiting?
WHERE CAN I GE T MORE INFORMATION?
Ask your health care team for more information about
managing your nausea and vomiting:
Self-management classes:
Nausea is an unpleasant feeling
in the back of your throat
and stomach.
It can make you have more saliva
(spit), clammy skin, a fast heart
rate or feel light-headed.
Vomiting is “throwing-up” the
stomach contents through
the mouth.
Nausea can make you feel:
• Sick to your stomach
• Queasy
• Like you have ‘butterflies’ in
your stomach
Local support groups:
Videos:
Books:
Pamphlets:
Vomiting may or may not happen
with nausea.
When your stomach is empty you
may have retching or “dry heaves”.
Nausea and vomiting
are serious symptoms
of cancer treatment that
can have a big impact on
your life. It is important
to get help as soon
as possible.
2
Ask your health care team who to contact if your
symptoms are so bad that you need help right away.
15
Where can I get more
information?
For links to these and other helpful resources please go to
www.cancercare.on.ca/symptoms
Websites:
Book:
Cancer Care Ontario
www.cancercare.on.ca
Goes Down Easy:
Recipes to help you cope with
the challenge of eating during
cancer treatment —
Elise Mecklinger, 2006.
Canadian Cancer Society
www.cancer.ca
Nourish
http://www.nourishonline.ca
Support Services:
Canadian Cancer Society
Community Services Locator
www.cancer.ca/csl
Canadian Cancer Society
Peer Support Service
www.cancer.ca/support
Cancer Chat Canada
www.cancerchatcanada.ca
What causes
nausea and vomiting?
This picture shows things that can cause
nausea and vomiting:
Cancer itself
History of nausea
and vomiting
Medications
Booklets:
Call the Canadian Cancer Society
to be mailed a copy of the two
booklets below
1-888-939-3333
Complementary therapies:
A guide for people with cancer
Cancer
treatments
Headache
Causes of nausea
and vomiting
Pain
Constipation
Eating well when you
have cancer
Infection
Other medical
problems
Motion sickness
Anxiety
14
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What can I do to manage
my nausea and vomiting?
WHEN SHOULD I TALK TO MY HEALTH CARE TEAM?
Use the boxes below to help your health
care team understand your symptom.
Take Anti-Nausea Medications
It is easier to prevent nausea with medications
than it is to treat it once it starts.
Take your medication as your
health care team prescribed.
There are two types of
anti-nausea medications:
1. Some medications are taken at
regular, set times to prevent and
control nausea.
2. Other medications may be
taken as you need them if you
feel nauseous in between your
regular medications. Taking too
much can cause side effects.
Be safe!
Do not use more of the as
needed medication than
allowed in a day.
Talk to your doctor,
pharmacist or nurse about
when and how to take your
anti-nausea medications.
4
Remember:
No medication can control
nausea and vomiting all
of the time.
Most anti-nausea medications
take 20 to 60 minutes before
they start to work.
Patient story:
“I was given so many
medications at the beginning
of treatment that I was
confused about what each was
for. Ask the pharmacist to mark
which bottle contains the pills
to take when you start to feel
nauseous. Then you will be
able to find the bottle quickly
when you need to take it.”
0 is no nausea and vomiting and 10 is the worst possible nausea
and vomiting.
1-3
4-6
7-10
You may have
Mild nausea and
vomiting if:
You may have
Moderate nausea and
vomiting if:
You may have Severe
nausea and vomiting if:
It goes away after
it is treated
It does not go away
within 6 hours after
treatment
You do not feel thirsty
You are not as hungry
but you are still able
to eat
You feel thirsty or have
a dry mouth
You are unable to eat
or drink for 24 hours
You are not able to
keep any water, food or
pills in your stomach.
There is blood or what
looks like ‘coffee
grounds’ in your vomit
You have severe
stomach pain
or headache
You lose weight
You are weak,
dizzy, confused
or very drowsy
Your health care team wants to know about your nausea
and vomiting. Your questions and concerns are important.
Do not be afraid to share them.
13
When should I talk
to my health care team?
Tell your health care team right away
if you have these symptoms:
You are not able to keep any water,
food or pills in your stomach
Severe nausea that lasts for more
than 24 hours
You are weak, dizzy and confused
What should I do if I vomit?
Stop eating and drinking for
30-60 minutes. Then start eating
and drinking slowly in this order:
1. Clear liquids
(like water, ice chips,
watered down juice, broth,
gelatin, popsicles)
2. Dry starchy food
(like crackers or dry toast)
3. Protein rich foods
(like chicken, fish or eggs)
What is symptom screening?
In Ontario, patients with cancer fill
out a symptom screening tool. The
screen tells your health care team
about your symptoms and how you
are feeling. The tool is called the
Edmonton Symptom Assessment
System (ESAS).
WHAT CAN I DO TO MANAGE MY NAUSEA AND VOMITING?
Doing your symptom
screening helps you and
your health care team to
manage your symptoms.
4. Dairy foods
(like yogurt, milk or cheese)
To keep your mouth clean, rinse
with a bland rinse after vomiting.
Homemade mouth rinse
Mix together:
1 teaspoon salt
1 teaspoon baking soda
4 cups water
If you have severe nausea and vomiting
Anti-nausea medications will
often be prescribed on a
regular schedule.
“As needed” medications may
be taken as well as your
regularly scheduled nausea
medication.
Drink small amounts of liquids.
12
If you vomit in between your
regular anti-nausea medication
doses, take your “as needed”
medication. Wait 30-60 minutes.
Then try drinking liquids and
continue with steps 2 to 4.
If you are not able to keep pills
down, speak to your health
care team about other ways to
take them (like using
dissolving tablets,
suppositories or injections).
If you are not able to drink,
you may need to get liquids
though an IV to keep
you hydrated.
5
WHAT CAN I DO TO MANAGE MY NAUSEA AND VOMITING?
WHAT CAN I DO TO MANAGE MY NAUSEA AND VOMITING?
Make Lifestyle Changes
Find Support
You don’t have to cope with your
nausea and vomiting alone. You can
find support in your community and
through your health care team.
These tips can help you find support:
Wear loose clothing. Clothing that
is tight around the waist can make
nausea worse.
Relax and take your time while
eating. Eating too quickly can
make nausea worse.
Sit up for 30-60 minutes after
eating. Lying down right after a
meal can cause nausea.
Rinse your mouth with a bland
rinse (p.5) before eating to keep it
clean and moist.
6
Brush your teeth 30 minutes after
eating and before bed (at least 4
times a day). This helps to get rid
of tastes in your mouth that make
you feel sick.
Suck on hard candies or lemon
drops to get rid of bad tastes in
your mouth.
Change your position when you
start to feel sick.
Plan work or activities for the times
of day when you usually feel better.
Ask family or friends to help you
with things like housework,
shopping, and child or pet care.
Talk with someone you trust about
how you are feeling.
To learn more about
online support groups,
check out Canadian Cancer
Society’s Peer Support Service.
Go to www.cancer.ca/support
Join a support group. There are
cancer support groups online or
your health care team can help
you find one in your community.
Take care of your spiritual needs
through nature, religion or
activities that bring you peace of
mind like writing in a journal.
11
WHAT CAN I DO TO MANAGE MY NAUSEA AND VOMITING?
WHAT CAN I DO TO MANAGE MY NAUSEA AND VOMITING?
Learn to Relax
Drink and Eat Well
Relaxation exercises can help you feel
more in control of your mind and your
body when you get nauseous.
What should I drink to help my
nausea and vomiting?
These activities can help you relax:
Progressive muscle relaxation
(to learn more go to
www.anxietybc.com and search
progressive muscle relaxation)
Deep breathing exercises
Take a walk outside or breathe
fresh air through an open window
Watch TV or a movie
Listen to music
To learn about
complementary treatments
and relaxation exercises,
talk to:
• Counsellors with a
background in psychosocial
care, anxiety reduction or
social work
• Spiritual care providers
• Primary care providers
Drinking
Sip small amounts of liquids often
during the day. As your nausea
starts to get better, add different
drinks and foods, slowly increasing
the amounts.
Drink at least 6 - 8 cups of liquids
per day unless you’ve been told to
drink less.
Drink cool liquids. They may
be easier to drink than hot or
cold liquids.
What drinks should I limit?
Caffeine, including coffee
and caffeinated soft drinks
(cola)
Alcohol
Some patients say that ginger
or peppermint make them feel
better. Check with your health
care team before taking these
or any natural health products.
Drink liquids and eat foods
separately, at least 30
minutes apart.
Ask your health care
team to refer you to a
registered dietitian.
A dietitian can help you
find ways to eat and drink
well when symptoms make
it a challenge.
You can also visit
EatRightOntario.ca or call
1-877-510-5102 to speak to a
registered dietitian for free.
10
Water, watered down juice
or sports drinks, flat ginger
ale, lemonade, broths and
non-creamy soups
Suck on ice chips, popsicles
or frozen fruit
Drink liquids, even when
you do not feel thirsty. It is
important to stay hydrated
7
WHAT CAN I DO TO MANAGE MY NAUSEA AND VOMITING?
Eating
What should I eat to help
my nausea and vomiting?
First try foods that are
dry, starchy or bland, like:
Crackers, pretzels, dry toast
or cereal
Boiled potatoes, noodles,
gelatin (like Jello), rice
If you feel better, add more
food, like:
Light broth soups
Broiled, boiled or baked lean
meat, poultry and fish
Skim or 1% milk, low fat
yogurt, cheese
Fresh, frozen or canned fruit
and vegetables
What foods should I limit?
• Fatty, fried meats and eggs
• Gravy, rich sauces, cream,
sour cream
• Onion, garlic
• Doughnuts, pastries,
sweet desserts
• Very spicy foods
WHAT CAN I DO TO MANAGE MY NAUSEA AND VOMITING?
Use Complementary Therapies
Eat small amounts every 2-3
hours. Many small meals can be
easier to eat than 3 larger meals.
Hunger can make feelings of
nausea stronger.
If the smell of food or drinks
bothers you:
These therapies may
help you feel better:
Acupuncture
Acupressure
Drink liquids through a straw to
avoid their smell.
Guided imagery
Eat cold or room temperature
foods. They do not smell as strong
as hot foods.
Distraction techniques
Open a window or use a fan to get
rid of food smells in the room.
If possible, stay out of the kitchen.
Ask someone else to prepare
meals. Buy prepared meals.
For more information on these
strategies see the Canadian
Cancer Society’s guide on
Complementary Therapies. Go
to www.cancer.ca/publications
Hypnosis
Visualization
Music therapy
Biofeedback (training your body to
do things, like slow your heart rate)
Get some fresh air. It may
reduce nausea.
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